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A year with ACA exchanges, some progress, more opportunity

Health careNearly a year after the health insurance exchanges opened for the first time, there are many uninsured people who are still unaware of how and when to get health insurance coverage. A recent Kaiser Family Foundation survey found that almost 90 percent of the nearly 41 million remaining uninsured Americans are unaware that open enrollment for the exchanges begins in November. Only 53 percent know that the Affordable Care Act (ACA) provides financial assistance, such as Medicaid and premium subsidies, to low and moderate income Americans. Almost 60 percent of the survey respondents, however, said they expected to get coverage within the next few months.

The open enrollment period in 2015 lasts just three months, from November 15th, 2014 to February 15th, 2015, three months shorter than last year’s open enrollment period. If the uninsured miss the open enrollment period, only a qualifying life event (such as marriage, divorce, birth, certain types of relocation) will allow the purchase of health insurance after the three-month enrollment period ends. Otherwise, one would be uninsured and shut out from the exchanges for another year. Given that one important goal of the health care legislation was to cover the neediest uninsured Americans, this news reinforces the need for a reliable and effective information stream to people with limited knowledge about their health insurance options.

Data from a recent Gallup Poll show the highest regional uninsured rates are in the South, where about 17 percent of the population remains without insurance. In comparison, just under 10 percent of people living in the Northeast and Midwest are currently uninsured. The reduction in the share of uninsured reflects the limited success of the Affordable Care Act in reaching uninsured Americans, especially in the South. It has been most effective in the West, where the percentage of uninsured has fallen from 19.2 percent to 13.9 percent in the last four quarters. One year after implementing the exchanges, the national uninsured rate sits at 13.4 percent, a 3.7 percentage point drop from the fourth quarter of 2013, according to Gallup.

Blog-Uninsured Chart

Source: Gallup-Healthways Well Being Index

Despite the fact that the ACA expanded the roles of private and public health insurance, approximately 41 million Americans still remain without health insurance coverage. Of these 41 million uninsured, an estimated 11 million are eligible for federal subsidies to purchase private insurance; almost 12 million are eligible for Medicaid, and 23 million uninsured live in states that opted out of Medicaid expansion, according to the Kaiser Family Foundation. In these non-expansion states, about five million Americans fall into the coverage gap, ineligible for either Medicaid or exchange subsidies, according to AIER estimates.

The reduction in the uninsured rate of 3.7 percentage points in the first year is only slightly lower than CBO estimates from January 2013. The delayed implementation of the exchanges may be another reason for the slower than expected enrollment. Major technical and logistical issues plagued the online exchanges, from faulty software to legal disputes between contractors. Updated CBO estimates predict another 7 million uninsured will purchase coverage in 2015, reducing the uninsured rate to 10 percent in the U.S. This will be dependent on the navigability and efficacy of the exchanges, but also reliant on the government and interest groups’ ability to reach the uninsured population with information about financial assistance incentives.

For more information on the Affordable care act’s provisions as they relate to federal assistance programs and eligibility under the law, see AIER’s study on the Affordable Care Act.

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